Provider Demographics
NPI:1316618671
Name:MARTINEZ, TATIANA ROSE (RPH,PHARMD)
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:ROSE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:RPH,PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1599 SE N ST APT G202
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-4086
Mailing Address - Country:US
Mailing Address - Phone:917-626-9629
Mailing Address - Fax:
Practice Address - Street 1:1642 WILLIAMS HWY
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5660
Practice Address - Country:US
Practice Address - Phone:541-479-6698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-25
Last Update Date:2021-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0018611183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist